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ObjectivesMethodsResultsConclusionsClinical implicationsData on the direct and indirect associations between physical activity (PA) and sleep quality in old age via psychosomatic mechanisms (e.g. mobility, pain, loneliness, depression, and anxiety) remain scarce in low- and middle-income countries (LMICs). We explored the association of PA with poor sleep quality (PSQ) among individuals aged ≥ 50 in Ghana and explored the potential mediating factors in this association.We analyzed community-based data from the Aging, Health, Psychological Well-being, and Health-seeking Behavior Study. We assessed PA using the International Physical Activity Questionnaire (IPAQ). Two items on nighttime and daytime sleep problems in the last 30 days were used to measure PSQ. Multivariable ordinary least square (OLS) regressions and bootstrapping models were performed to evaluate the associations.Overall, 1,201 participants (Mage = 66.15 ± 11.58 years; 63.3% female) were included in the analysis. PA was independently associated with decreased PSQ in the overall sample (B = −0.181, 95%I = −0.271 to −0.092) and in women (B = −0.195, 95%I = −0.305 to −0.084). The association was stronger in the ≥ 65 (B = −0.138) than in the 50–64 age group (B = −0.213). Mobility (37.06%), pain (23.66%), loneliness (6.71%), and comorbid anxiety and depression (8.95%) mediated the PA-PSQ association.PA was associated with decreased PSQ levels, which was particularly explained by psychosomatic factors.Clinicians encourage older adults to engage in regular PA and manage psychosomatic problems may improve their sleep health. [ABSTRACT FROM AUTHOR]